采用细胞减灭术（CRS）和腹腔内热灌注化疗（HIPEC）治疗阑尾癌所致腹膜表面疾病（PSD）：481例病例综述
Peritoneal surface disease (PSD) from appendiceal cancer treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC): overview of 481 cases.
作者信息
Votanopoulos Konstantinos I, Russell Greg, Randle Reese W, Shen Perry, Stewart John H, Levine Edward A
机构信息
Section of Surgical Oncology, Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, NC, USA,
出版信息
Ann Surg Oncol. 2015 Apr;22(4):1274-9. doi: 10.1245/s10434-014-4147-y. Epub 2014 Oct 16.
BACKGROUND
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) used to treat peritoneal surface disease (PSD) from appendiceal cancer have shown variability in survival outcomes. The primary goal of this study was to determine predictors of surgical morbidity and overall survival. The secondary goal was to describe the impact of nodal status on survival after CRS/HIPEC for PSD from low-grade appendiceal (LGA) and high-grade appendiceal (HGA) primary lesions.
METHODS
A retrospective analysis of 1,069 procedures from a prospective database was performed. Patient characteristics, tumor grade, nodal status, performance status, resection status, morbidity, mortality, and survival were reviewed.
RESULTS
The study identified 481 CRS/HIPEC procedures: 317 (77.3 %) for LGA and 93 (22.7 %) for HGA lesions. The median follow-up period was 44.4 months, and the 30-day major morbidity and mortality rates were respectively 27.8 and 2.7 %. Major morbidity was jointly predicted by incomplete cytoreduction (p = 0.0037), involved nodes (p < 0.0001), and comorbidities (p = 0.003). Multivariate negative predictors of survival included positive nodal status (p = 0.003), incomplete cytoreduction (p < 0.0001), and preoperative chemotherapy (p = 0.04) in LGA patients and incomplete cytoreduction (p = 0.0003) and preoperative chemotherapy (p = 0.0064) in HGA patients. After complete cytoreduction, median survival was worse for patients with positive nodes than for those with negative nodes in LGA (85 months vs not reached [82 % alive at 90 months]; p = 0.002) and HGA (30 vs 153 months; p < 0.0001).
CONCLUSIONS
Positive nodes are associated with decreased survival not only for HGA patients but also for LGA patients even after complete cytoreduction. Nodal status further stratifies histologic grade as a prognostic indicator of survival. Patients with node-negative HGA primary lesions who receive a complete cytoreduction may experience survival comparable with that for LGA patients.
背景
细胞减灭术（CRS）及腹腔热灌注化疗（HIPEC）用于治疗阑尾癌所致腹膜表面疾病（PSD），其生存结果存在差异。本研究的主要目的是确定手术并发症及总生存的预测因素。次要目的是描述淋巴结状态对低级别阑尾（LGA）和高级别阑尾（HGA）原发性病变所致PSD患者接受CRS/HIPEC治疗后生存的影响。
方法
对前瞻性数据库中的1069例手术进行回顾性分析。对患者特征、肿瘤分级、淋巴结状态、体能状态、切除状态、并发症、死亡率及生存情况进行了评估。
结果
该研究共纳入481例CRS/HIPEC手术：LGA病变317例（77.3%），HGA病变93例（22.7%）。中位随访期为44.4个月，30天严重并发症和死亡率分别为27.8%和2.7%。细胞减灭不完全（p = 0.0037）、存在转移淋巴结（p < 0.0001）及合并症（p = 0.003）共同预测严重并发症的发生。多因素分析显示，LGA患者生存的负性预测因素包括淋巴结阳性（p = 0.003）、细胞减灭不完全（p < 0.0001）及术前化疗（p = 0.04）；HGA患者生存的负性预测因素包括细胞减灭不完全（p = 0.0003）及术前化疗（p = 0.0064）。细胞减灭完全后，LGA患者中淋巴结阳性者的中位生存期（85个月）短于淋巴结阴性者（未达到[90个月时82%存活]；p = 0.002）；HGA患者中淋巴结阳性者的中位生存期（30个月）短于淋巴结阴性者（153个月；p < 0.0001）。
结论
即使细胞减灭完全，淋巴结阳性不仅与HGA患者生存降低有关，也与LGA患者生存降低有关。淋巴结状态进一步细化了组织学分级作为生存预后指标的分层。接受细胞减灭完全的淋巴结阴性HGA原发性病变患者的生存情况可能与LGA患者相当。
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